Healthcare Provider Details

I. General information

NPI: 1982198958
Provider Name (Legal Business Name): VICTORIA ANNE BLACKHURST DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 CENTERVILLE RD STE 205
WILMINGTON DE
19808-1664
US

IV. Provider business mailing address

2710 CENTERVILLE RD STE 205
WILMINGTON DE
19808-1664
US

V. Phone/Fax

Practice location:
  • Phone: 302-707-6757
  • Fax:
Mailing address:
  • Phone: 302-707-6757
  • Fax: 302-707-6756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1858465
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberG1-0011512
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: